Planning framework: Management of Drug Resistant TB

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Planning framework Management of Drug Resistant
TB

• Fuad Mirzayev, GLC Secretariat, WHO
• Stop TB workshop on TB proposal preparation for
  round 6 of the GFATM
• 15-18 May 2006, John Knox Center, Geneva

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Round 6 - New Environment

• Guidelines for the programmatic management of
  DR-TB
• Standards of TB care
• New Stop TB strategy
• Global plan to Stop TB 2006-15 800,000 MDR-TB
  patients to treat

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http//whqlibdoc.who.int/publications/2006/9241546
956_eng.pdf
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Collaboration with the GFATM

• "To help contain resistance to second-line
  anti-TB drugs and consistent with the policies of
  other international funding sources, all
  procurement of medications to treat MDR-TB must
  be conducted through the Green Light Committee
  (GLC)"
• Third Board Meeting, 10-11 October, 2002
• The board reaffirms its decision taken at its
  Third Board Meeting
• The Board decides that applicants must include a
  cost-sharing element for Green Light Committee
  services. To limit transaction costs this will be
  defined by the secretariat in consultation with
  the Green Light Committee as a flat rate per
  grant per year that will not exceed US 50,000
  per grant per year.
• Thirteenth Board Meeting, 27-28 April, 2006
• The Global Fund to Fight AIDS, Tuberculosis and
  Malaria

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GLC approved projects
Azerbaijan Bangladesh Bolivia Cambodia Costa
Rica DR Congo Dominican Republic Ecuador Egypt El
Salvador Estonia Georgia Guinea Haiti Honduras I
ndia Jordan Kenya Kyrgyzstan Latvia
Lebanon Lithuania Malawi Mexico Moldova Mongolia
Nepal Nicaragua Peru Philippines Romania Russia
Syria Timor Leste Tunisia Uzbekistan
GLC-approved projects in 36 countries
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The crucial role of the GFATM
Azerbaijan Armenia Bangladesh Bolivia China Domin
ican Republic DR Congo Ecuador Egypt El Salvador
Georgia Honduras India Indonesia Jordan Kenya K
yrgyzstan Moldova Mongolia Nicaragua Paraguay Peru
Philippines Romania Russia Serbia Uzbekistan
GFATM approved proposals with MDR-TB component
(27)
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GLC model components
Monitoring and evaluation
Expert committee
Procurement Services
GLC secretariat
Gupta R, Irwin A, Raviglione MC, Kim JY Lancet
2004363 320-324
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GLC model action cycle
Country/Project
WHO
GDF
Expert committee GLC
GLC secretariat
Procurement
Pharmaceuticals
ME
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Stop TB strategy component 2 Prevent and
control MDR-TB

• Prevent deaths and continued transmission of
  drug-resistant strains and creation of incurable
  forms of tuberculosis
• Integrate drug resistance surveillance and
  management of MDR-TB as routine components of TB
  control

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Activities gt MDR SDAs (1)

• Laboratory Support
• (not only bacteriology lab)
• DRS
• (important for the project design and selection
  of treatment strategy and drug forecasting)

http//whqlibdoc.who.int/publications/2003/9241546
336.pdf
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Activities gt MDR SDAs (2)

• Technical assistance
• (different from GLC services)
• Health Facilities
• (both in-patient and out-patient facility)
• Infection control
• Human Resources

http//www.who.int/docstore/gtb/publications/healt
hcare/PDF/WHO99-269.pdf
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Activities gt MDR SDAs (3)

• GLC services
• (50,000 flat rate per grant per year)
• Procurement of medicines
• (SLDs 2,000-3,000 US on average, drugs to
  treat adverse effects 5-10 from SLD cost,
  shipment costs)
• Social support

http//whqlibdoc.who.int/hq/2004/WHO_HTM_TB_2003.3
28_Rev.1.pdf
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Sequence of events
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Timing of GLC application

• Based on Instructions and follow principles
  outlined in the Guidelines
• Not necessary to be submitted with GFATM
  proposal, but
• Preparation has to start well before the planned
  initiation of MDR-TB patients enrollment
  (factoring application writing, GLC review,
  procurement lead times, importation)
• Baseline situation very important, incremental
  approach vs. whole country projects.

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Questions?
Fuad Mirzayev mirzayevf_at_who.int